WCBVI Textbook Request Form 2021-2022

If you have questions please contact:
Marilyn Connolly,
Coordinator, Accessible Instructional Materials
Email *
Student Name
Opt In Statement: By completing the student name section this form, you state that you understand that student name is Personally Identifiable Information (PII). If you do not wish to share your students PII on this form, please leave a message with 1. your name, 2. the date of your book request, and 3. the student name for our AIM Coordinator at (608) 758-6146.
Is this student registered on the current APH Census and eligible for the federal quota program? *
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